A Survey on Activities of Daily Living and Occupations of Upper Extremity Amputees

OBJECTIVE: To assess prosthetic use by upper extremity amputees, and their difficulties with prostheses in activities of daily living and occupations. METHOD: This study is based on a survey of 307 subjects, who were using prostheses manufactured in the Center of Prosthetics and Orthotics. The survey questionnaire included items about general demographic characteristics, side and level of amputation, type of prosthesis and its use, and difficulties in the activities of daily living, employment and driving. RESULTS: The most common type of prosthesis was the cosmetic hand type (80.2%). There were no statistically significant correlations between satisfaction with prosthesis and the amputation level or type of prosthesis. The most common difficulties in daily living activities experienced by amputees were lacing shoes, removing bottle-tops with a bottle opener, and using scissors. Only 7.3% of amputees received rehabilitation services. Less than half of the amputees (44.7%) used their prostheses for eight or more hours a day, and 76.9% used their prostheses for regular or irregular cosmetic purposes. After amputation, most of the respondents (69.0%) became unemployed or changed workplaces. CONCLUSION: In our study, respondents preferred cosmetic usage to functional usage. Only 30.0% of respondents reported satisfaction with their prostheses. Many of the amputees had difficulties in complex tasks and either changed jobs or became unemployed. Clerical workers were the occupation group, which was most likely to return to work. The development of a more functional prosthetic hand and additional rehabilitation services are required.

Effect of Tracheostomy Tube on Swallowing in Patients with Stroke

OBJECTIVE: To investigate the characteristics and severity of swallowing difficulties among stroke patients with a tracheostomy tube, compared to those without. METHOD: A retrospective study was performed on two groups of 17 stroke patients with a tracheostomy tube (58.8 years) and without a tracheostomy tube (69.8 years) fed by Levine tube or a gastrostomy tube. There were no differences in the FIM (functional independence measure) score and brain lesions between the two groups. We evaluated the functional dysphagia scale (FDS) and aspiration; classified before, during, and after swallowing aspiration and silent aspiration. The swallowing task consisted of 2 ml of fluid and a videofluoroscopic swallowing study. RESULTS: There were no significant differences between the oral preparatory, oral and pharyngeal phase for the two groups in FDS. However, frequency of silent aspiration (p=0.007) and the total frequency of aspiration (p=0.038) were significantly higher in patients with tracheostomy. CONCLUSION: Patients with stroke who underwent tracheostomy showed no meaningful difference in FDS. However, there were significant differences in terms of silent aspiration and the total frequency of aspiration; caused by laryngopharyngeal desensitization and the anterior tethering effect on the tracheostomy tube. We have to pay more attention to the treatment and care of patients with tracheostomy tubes.

Gait Characteristics of Transfemoral Amputees in Long Term Users of Poly Centric Knee

OBJECTIVE: To evaluate characteristic gait patterns of transfemoral amputees who have been using polycentric knee for a long time. METHOD: Subjects were 22 transfemoral amputees using prosthesis for 29.0 years and 23 age-matched healthy adults. The three-dimensional gait analysis was performed. Temporospatial, kinematic and kinetic parameters were measured. RESULTS: Cadence and walking velocity of amputees decreased (p<0.05). Single support period decreased in amputee limb. There were no significant differences in hip flexion moment and power. In amputated limb, knee flexion in loading response was not observed and ankle plantar flexion was less than sound limb and control group. Excessive compensations of amputee side hip joint were not significant. CONCLUSION: Long term polycentric knee unit transfemoral prosthesis users show asymmetry of gait pattern which can increase the risk of musculoskeletal problems. Epidemiologic investigation would be necessary for prevention and proper management.

Crossing Obstacles of Different Heights in Hemiplegic Stroke Patients

OBJECTIVE: To evaluate the changes of gait patterns during crossing obstacles of different heights in hemiplegic stroke patients and to compare gait characteristics with those of healthy control subjects. METHOD: Subjects were 13 hemiplegic stroke patients and 9 age-matched healthy adults. Subjects stepped over obstacles with each height of 3, 8 and 13 cm. The three- dimensional gait analysis was performed. Temporospatial, kinematic and kinetic parameters were measured in both lead and trail limb. The pre- and post-obstacle distance, pre- and post-obstacle swing time and toe clearance were also measured. RESULTS: With increase in height of obstacles, ratio of single limb support time, angle of hip, knee flexion in swing phase and hip extensor moment increased in both lead and trail limbs. In the lead limb, post-obstacle distance and toe clearance also increased (p<0.05). Compared with control groups, the angle of knee flexion, hip extensor and hip flexor moment and pre- and post-obstacle distance decreased significantly in the lead limb of hemiplegic patients (p<0.05). In the trail limb of hemiplegic patients, the angle of hip flexion, hip flexor moment and post-obstacle distance decreased (p<0.05). CONCLUSION: Understanding strategies for adequate control and coordination of the swing limb during crossing obstacles may be the basis for the safe training of obstacle crossing in hemiplegic stroke patients.

Mean Values and Correlations between Rotational Profiles of Bilateral Lower Extremities in Korean Elderly Men

0OBJECTIVE: To investigate the mean values and correlations between the rotational profiles of bilateral lower extremities in Korean elderly men. METHOD: 100 lower extremities were examined for the rotational profiles of bilateral lower extremities with radiographic examination. RESULTS: The mean values of femoral anteversion, axial rotation of the knee joint, proximal and distal tibial torsion, bimalleolar axis (BMA), and Q angle were 8.72degrees, 0.19degrees, 34.53degrees, 26.25degrees, 20.97degrees, 5.65degrees. In Korean elderly men, the result of tibial torsion and Q angle was smaller than the results of other studies, and the bilateral differences were detected in the measured profiles of lower extremities, except axial rotation of the knee joint. However, all profiles represented a positive correlation between right and left lower extremities. The correlation between proximal tibial torsion and BMA had a positive correlation, But the femoral anteversion and tibial torsion had no correlations among the profiles in Korean elderly men. CONCLUSION: We suspected that Korean elderly healthy men have reduced tibial torsion and more genu varus alignment, and the rotational profiles of lower extremities showed side to side difference, but there were symmetrical tendency. It will be helpful in assessing the evaluation, treating, researching of the musculoskeletal problem in Korean elderly people.